Opinion
A measure of good practice
The new Nursing and Midwifery Council Code creates opportunities, writes chief nursing officer for Wales Jean White THE REVISED Nursing and Midwifery Council Code came into effect on March 31. Each revision marks a milestone in the development of the nursing and midwifery professions. It sets out a contemporary explanation of the standards of professional practice and behaviour expected of registrants. One of the hallmarks of being a profession is that members, their employers and the public understand clearly what to expect from practitioners. The Code is the measure against which the actions and behaviours of nurses and midwives are to be measured. This makes it more than just a useful reference document that practitioners pick up from time to time; it must be central to our thinking as we go about our daily practice. The development of this version of the Code has been heavily influenced by
reports such as the Francis Inquiry in 2013, and the Winterbourne View and Morecambe Bay investigations. It could be argued that the public perceptions of the nursing and midwifery professions has been tarnished by such reports and work needs to be done to help re-instil confidence where it has been lost. In this respect, the new Code can be seen as an opportunity to remind the public that there are systems to protect them from the small number of practitioners who fail, for one reason or another, to deliver safe and compassionate care. The new Code stipulates that registrants will ‘be a model of integrity and leadership for others to aspire to’, and this means all the time, not just at work. Though this expectation is nothing new, it is a timely reminder about what it means to be a professional not
just an employee doing a job. There are six areas of change in the new Code, one of which is the duty to take action in an emergency even when off duty, within the limits of the individual’s competence. Some practitioners may fear the consequences should their interventions be unsuccessful, but it has been made clear that failure to act is unacceptable. Off duty rules Similarly, the way in which registrants use social media, which now pervade all areas of society, needs to comply with the Code. It does not matter whether a tweet or Facebook entry is made while the registrant is off duty, if it breaches confidentiality or is unprofessional in any discernible way, registrants will be held to account for their actions. The Code has been structured under four themes, one of which is ‘preserve safety’. The statements in this section are crafted to respond actively to various care failures in recent years, by emphasising registrants’ responsibility
Spread the news about the Code Managers are pivotal to the new standards, says NMC director of continued practice Katerina Kolyva THE NURSING and Midwifery Council (NMC) Code sets out the standards that registered nurses and midwives must uphold to maintain their registration. It is the standard against which good nursing and midwifery practice is judged, and should regularly be referred to by professionals to inform practice. The Code reflects public expectations of those who deliver care. We launched the revised Code in January and it took effect on March 31. The Code is the product of a thorough consultation process, 12 May 2015 | Volume 22 | Number 2
and represents modern practice. It is the foundation for the revalidation process, which we will launch in October. The Code has been re-structured, and is now divided into four themes: prioritise people, preserve safety, practise effectively, and promote professionalism and trust. The revised Code emphasises leadership, as we recognise the importance of healthcare leaders in establishing the culture of an organisation and improving standards of care. Staff, resources and time must be properly managed in order for the Code to apply in practice. Revalidation will support public protection by ensuring that nurses and midwives reflect on and affirm their practice against the standards in the Code, bringing it closer to daily delivery of care and individual performance. The revised Code and revalidation will drive improvements in standards, leading to better patient care.
Revalidation replaces post-registration education and practice (prep), and all nurses and midwives will revalidate every three years at their renewal dates. We are piloting the revalidation process in various NHS and non-NHS settings across the UK. While the Code and revalidation will affect all nurses and midwives, managers and senior staff must help to support the nurses and midwives at their practice settings by getting ready for revalidation now. You can raise awareness of the proposed model among your colleagues, so that every nurse and midwife understands what is expected of them. Notice boards or team briefings are ideal for this purpose. Through revalidation, nurses and midwives will seek and reflect on feedback from service users, their continuing professional development (CPD) activities and the Code. NURSING MANAGEMENT
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to act appropriately when they see something that may affect the safety of patients in a care setting. The attitude ‘not my patient, not my problem’ is not acceptable. If registrants say or do nothing about poor care they observe, it means they have accepted this level of care and tacitly agree with
it. This change recognises that too often teams know staff members are behaving inappropriately or that a ward has worse outcomes than another similar one, yet nothing is done. Such ‘wilful blindness’ can be dangerous in many walks of life, but especially so in health care. If we refuse to address
Revalidation replaces Prep, and all nurses and midwives will revalidate every three years at their renewal dates.
Reflective accounts will be discussed with other registered nurses or midwives. These discussions will focus in each case on how the revalidation embraces the values and principles of the Code into everyday practice. This will help to challenge professional isolation and improve standards of care. Professionals who revalidate will also need to receive confirmation from a line manager that they have met the revalidation requirements. You will be instrumental in supporting nurses and midwives in your organisation and in setting the tone of engaged professionalism throughout the process. Normally, nurses and midwives will seek this confirmation through their appraisals. Revalidation requirements are not new: nurses and midwives will still be required to practise at least 450 hours over three years, and declare they have appropriate indemnity arrangements. They will continue to complete CPD activities, but the number of hours we ask for is likely
To gather the feedback from service users, which is central to revalidation, nurses and midwives may call on existing feedback mechanisms, such as the family test or patient and user surveys. Team meetings where nurses and midwives reflect on their practice as part of the group are also environments to use for reflecting on the Code. Feedback obtained through these channels will be reflected on in one of several pieces of written reflection. The feedback may not be directed specifically at the nurse or midwife who is revalidating; it may be general towards a team. What we are interested in is that the feedback has been used to reflect on, and improve, practice. NURSING MANAGEMENT
poor care, patients suffer, but too often practitioners hope that others will deal with the problem or that it will just go away. It takes courage to act and the way that whistleblowers have been treated historically makes it easy to understand why individuals can be reluctant to act. It is incumbent on all of us to develop an organisational culture that is open to addressing concerns so that we don’t need ‘brave souls’ to speak out in order for something to change. Some organisations are taking steps to develop such an open culture. Abertawe Bro Morgannwg University Health Board, for example, is running a ‘See It, Say It’ campaign, to make it simpler for patients, visitors and healthcare staff to report concerns about poor care so they are handled earlier. This campaign has used posters throughout health board sites to raise awareness and has set up dedicated reporting arrangements that allow reporters to remain anonymous if they want. I welcome the new Code as it offers each of us the opportunity to consider what it means to be a nurse or midwife in a modern health and social care system. Jean White is chief nursing officer for Wales
to rise from 35 to 40, of which half should be met through participatory learning. Participatory learning includes any activity in which a nurse or midwife personally interacts with one or more professionals. More than ever before, patients have a say in how their care is planned and administered, and we recognise how important it is that our regulatory functions take this into account. The reflective aspect of the revalidation process will provide insights into how nursing and midwifery professions are practising. Improvements brought about by revalidation should contribute to enhancing patient safety, and increase the confidence of nurses, midwives and their employers. However, for its introduction to be successful, revalidation needs to owned and embraced by individuals and organisations. Katerina Kolyva is director of continued practice at the Nursing and Midwifery Council
See also Vantage point, page 15 September 2014 | Volume 21 | Number 5 13
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A measure of good practice
The new Nursing and Midwifery Council Code creates opportunities, writes chief nursing officer for Wales Jean White THE REVISED Nursing and Midwifery Council Code came into effect on March 31. Each revision marks a milestone in the development of the nursing and midwifery professions. It sets out a contemporary explanation of the standards of professional practice and behaviour expected of registrants. One of the hallmarks of being a profession is that members, their employers and the public understand clearly what to expect from practitioners. The Code is the measure against which the actions and behaviours of nurses and midwives are to be measured. This makes it more than just a useful reference document that practitioners pick up from time to time; it must be central to our thinking as we go about our daily practice. The development of this version of the Code has been heavily influenced by
reports such as the Francis Inquiry in 2013, and the Winterbourne View and Morecambe Bay investigations. It could be argued that the public perceptions of the nursing and midwifery professions has been tarnished by such reports and work needs to be done to help re-instil confidence where it has been lost. In this respect, the new Code can be seen as an opportunity to remind the public that there are systems to protect them from the small number of practitioners who fail, for one reason or another, to deliver safe and compassionate care. The new Code stipulates that registrants will ‘be a model of integrity and leadership for others to aspire to’, and this means all the time, not just at work. Though this expectation is nothing new, it is a timely reminder about what it means to be a professional not
just an employee doing a job. There are six areas of change in the new Code, one of which is the duty to take action in an emergency even when off duty, within the limits of the individual’s competence. Some practitioners may fear the consequences should their interventions be unsuccessful, but it has been made clear that failure to act is unacceptable. Off duty rules Similarly, the way in which registrants use social media, which now pervade all areas of society, needs to comply with the Code. It does not matter whether a tweet or Facebook entry is made while the registrant is off duty, if it breaches confidentiality or is unprofessional in any discernible way, registrants will be held to account for their actions. The Code has been structured under four themes, one of which is ‘preserve safety’. The statements in this section are crafted to respond actively to various care failures in recent years, by emphasising registrants’ responsibility
Spread the news about the Code Managers are pivotal to the new standards, says NMC director of continued practice Katerina Kolyva THE NURSING and Midwifery Council (NMC) Code sets out the standards that registered nurses and midwives must uphold to maintain their registration. It is the standard against which good nursing and midwifery practice is judged, and should regularly be referred to by professionals to inform practice. The Code reflects public expectations of those who deliver care. We launched the revised Code in January and it took effect on March 31. The Code is the product of a thorough consultation process, 12 May 2015 | Volume 22 | Number 2
and represents modern practice. It is the foundation for the revalidation process, which we will launch in October. The Code has been re-structured, and is now divided into four themes: prioritise people, preserve safety, practise effectively, and promote professionalism and trust. The revised Code emphasises leadership, as we recognise the importance of healthcare leaders in establishing the culture of an organisation and improving standards of care. Staff, resources and time must be properly managed in order for the Code to apply in practice. Revalidation will support public protection by ensuring that nurses and midwives reflect on and affirm their practice against the standards in the Code, bringing it closer to daily delivery of care and individual performance. The revised Code and revalidation will drive improvements in standards, leading to better patient care.
Revalidation replaces post-registration education and practice (prep), and all nurses and midwives will revalidate every three years at their renewal dates. We are piloting the revalidation process in various NHS and non-NHS settings across the UK. While the Code and revalidation will affect all nurses and midwives, managers and senior staff must help to support the nurses and midwives at their practice settings by getting ready for revalidation now. You can raise awareness of the proposed model among your colleagues, so that every nurse and midwife understands what is expected of them. Notice boards or team briefings are ideal for this purpose. Through revalidation, nurses and midwives will seek and reflect on feedback from service users, their continuing professional development (CPD) activities and the Code. NURSING MANAGEMENT
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Opinion
to act appropriately when they see something that may affect the safety of patients in a care setting. The attitude ‘not my patient, not my problem’ is not acceptable. If registrants say or do nothing about poor care they observe, it means they have accepted this level of care and tacitly agree with
it. This change recognises that too often teams know staff members are behaving inappropriately or that a ward has worse outcomes than another similar one, yet nothing is done. Such ‘wilful blindness’ can be dangerous in many walks of life, but especially so in health care. If we refuse to address
Revalidation replaces Prep, and all nurses and midwives will revalidate every three years at their renewal dates.
Reflective accounts will be discussed with other registered nurses or midwives. These discussions will focus in each case on how the revalidation embraces the values and principles of the Code into everyday practice. This will help to challenge professional isolation and improve standards of care. Professionals who revalidate will also need to receive confirmation from a line manager that they have met the revalidation requirements. You will be instrumental in supporting nurses and midwives in your organisation and in setting the tone of engaged professionalism throughout the process. Normally, nurses and midwives will seek this confirmation through their appraisals. Revalidation requirements are not new: nurses and midwives will still be required to practise at least 450 hours over three years, and declare they have appropriate indemnity arrangements. They will continue to complete CPD activities, but the number of hours we ask for is likely
To gather the feedback from service users, which is central to revalidation, nurses and midwives may call on existing feedback mechanisms, such as the family test or patient and user surveys. Team meetings where nurses and midwives reflect on their practice as part of the group are also environments to use for reflecting on the Code. Feedback obtained through these channels will be reflected on in one of several pieces of written reflection. The feedback may not be directed specifically at the nurse or midwife who is revalidating; it may be general towards a team. What we are interested in is that the feedback has been used to reflect on, and improve, practice. NURSING MANAGEMENT
poor care, patients suffer, but too often practitioners hope that others will deal with the problem or that it will just go away. It takes courage to act and the way that whistleblowers have been treated historically makes it easy to understand why individuals can be reluctant to act. It is incumbent on all of us to develop an organisational culture that is open to addressing concerns so that we don’t need ‘brave souls’ to speak out in order for something to change. Some organisations are taking steps to develop such an open culture. Abertawe Bro Morgannwg University Health Board, for example, is running a ‘See It, Say It’ campaign, to make it simpler for patients, visitors and healthcare staff to report concerns about poor care so they are handled earlier. This campaign has used posters throughout health board sites to raise awareness and has set up dedicated reporting arrangements that allow reporters to remain anonymous if they want. I welcome the new Code as it offers each of us the opportunity to consider what it means to be a nurse or midwife in a modern health and social care system. Jean White is chief nursing officer for Wales
to rise from 35 to 40, of which half should be met through participatory learning. Participatory learning includes any activity in which a nurse or midwife personally interacts with one or more professionals. More than ever before, patients have a say in how their care is planned and administered, and we recognise how important it is that our regulatory functions take this into account. The reflective aspect of the revalidation process will provide insights into how nursing and midwifery professions are practising. Improvements brought about by revalidation should contribute to enhancing patient safety, and increase the confidence of nurses, midwives and their employers. However, for its introduction to be successful, revalidation needs to owned and embraced by individuals and organisations. Katerina Kolyva is director of continued practice at the Nursing and Midwifery Council
See also Vantage point, page 15 September 2014 | Volume 21 | Number 5 13
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